title: [Surgical technique for pancreas transplantation].
abstract: OBJECTIVE
  The transplantation of a cadaveric donor pancreas represents a therapeutic option for the type 1 diabetic. A precondition is the proof of negative serum C-peptide after glucagon stimulation (< 0.02 ng/ml) as it is found in the typical patient with type 1 or a pancreoprive diabetes. The pancreas can be transplanted alone (PTA) or after a kidney (PAK), either following a preceding living related or cadaveric kidney transplantation. The majority of pancreata worldwide are transplanted simultaneously with a kidney (SPK) in stage 4 and 5 (eGFR < 29 ml/min) of chronic kidney disease. The beneficial effect of physiological glucose regulation on mortality, kidney failure and diabetic complications (cardiovascular, neuropathy, retinopathy) is well established. Patient survival rate at 1 year after transplantation is above 90 %, pancreas graft survival overall after 1 year is about 80 %.
  
  
  METHODS
  Type 1 diabetic patients with recurrent hypoglycemic episodes or major complications due to dysregulated glucose metabolism qualify for pancreas transplantation alone in case of a stable kidney function. Patients with chronic kidney disease stage 4 and 5 are candidates for SPK.
  
  
  METHODS
  Pancreatic transplantation into the right iliac fossa.
  
  
  CONCLUSIONS
  Although technically demanding, pancreas transplantation is safely performable with a low periprocedural morbidity and mortality. Potential perioperative complications include inflammation, rejection or graft thrombosis. After a successful transplantation, long-term physiological glucose regulation can be achieved which results in a prolonged life expectancy and quality of life in type 1 diabetic patients.
authors.affiliation: Klinik und Poliklinik für Viszeral-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Ludwig
authors.forename: S
authors.initials: S
authors.lastname: Kersting
mesh_terms: D000328:Adult; D002102:Cadaver; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000601:surgery*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D016035:Pancreas Transplantation / Q000379:methods*